Kansas Medicaid coverage for Wegovy (Heart Disease

Medicaid

Covered with requirements

What you need to qualify

Age 18 and older
BMI of 27 or higher
6 months of a documented diet and exercise program
Established cardiovascular disease (MI, stroke, and PAD)
Not being used to treat type 1 diabetes

Qualification pathways

You can qualify through any one of these.

CV Risk Reduction — Adults with Established CVD and No Diabetes

All of:

Age >= 18 years
BMI >= 27 kg/m2
Established cardiovascular disease (history of myocardial infarction, stroke, or symptomatic peripheral arterial disease)
No history of Type 1 or Type 2 diabetes mellitus
Treatment plan includes comprehensive adjunct lifestyle interventions (diet modification, physical activity, behavioral therapy)
Prescriber provides baseline weight and BMI
Patient able to titrate and maintain therapeutic dose per FDA-approved labeling
Dose does not exceed 2.4 mg SC once weekly

Documentation to bring

Baseline weight and BMI documentation (BMI >= 27 kg/m2)
Documentation of established CVD (history of MI, stroke, or symptomatic PAD)
Documentation confirming no history of Type 1 or Type 2 diabetes mellitus
Documentation of comprehensive adjunct lifestyle intervention plan (diet, physical activity, behavioral therapy)

Quantity limits

2.4 mg — Per FDA-approved dosing; dose not to exceed 2.4 mg SC once weekly

Approval and renewal

Renewal: every 6 months
To renew, the plan looks for Continuation criteria for the CV risk reduction pathway are not separately specified beyond continued comprehensive adjunct lifestyle interventions. Table 4 high-cost agent renewal weight loss thresholds do NOT apply to Wegovy (as of 6/1/2025) and are explicitly excluded for this CVD pathway (Table 4 note states it does not apply to patients with baseline BMI >=27 and established CVD requesting Wegovy).

Not covered when

Type 2 diabetes mellitus — patients with T2DM are explicitly excluded from this CV risk reduction pathway and must use the formulation indicated for T2DM
Professional samples may not be used to establish patient history of medication usage
Type 1 diabetes

Policy note: This CVD pathway is carved out from the Table 4 'high-cost' additional criteria (including severe obesity BMI >=40 and 3-month lifestyle modification requirement) per explicit footnote in Table 4: 'does not apply to patients with baseline BMI >=27 and established cardiovascular disease for adult patients requesting Wegovy.' Initial approval duration is 28 weeks (as of 6/1/2025). Established CVD is defined as history of myocardial infarction, stroke, or symptomatic peripheral arterial disease.

Policy effective August 14, 2024 · verified June 4, 2026 · source: Anti-Obesity-Medications-PDF

Kansas Medicaid coverage for Wegovy (Heart Disease Risk Reduction)